Change: The Only Constant

Our Marriot van driver was taking us to the airport when a pleasant conversation revealed that he had been a highly successful sound man for a major New York studio prior to moving to Tampa four years ago. 

He was doing very well in the sound business but he got carried away with his own success. 

He was meeting all of the Hollywood movie stars that he used to admire on the big screen. This exposure to fame caused him to follow their example and he began using drugs. 

He became addicted to cocaine that led to a divorce and separation from his little girl. 

Although he is now driving a van he does not regret moving to Tampa because “sanity and health are more important than fame or wealth.” 

Heraclitus said that, "You cannot step twice into the same river; for fresh waters are ever flowing in upon you."  

In 500 BC the river of change was a tiny trickle.  Currently, the river of change exists at flood tide, roaring so swiftly that if you put your big toe in the stream you're liable to be swept away.

Although we may, at times, seem overwhelmed by the changes going around us, we can be encouraged by Edith Wharton's words:

In spite of illness, in spite of sorrow, one can remain alive long past the usual date of disintegration if one is unafraid of change, insatiable in intellectual curiosity, interested in big things and happy in small ways.

Diagnosis and Treatment of Adult Attention Deficit Disorder

Attention deficit disorder has been recognized as the most common under-diagnosed psychiatric disorder in adults and a major contributor to drug abuse, automobile and industrial accidents and underachievement.  

Characteristics of adult ADHD include: 

• Difficulty concentrating. 

• Inattention. 

• Reading, repeat reading, and rereading again to understand the material. 

• Difficulty initiating and finishing tasks. 

• Disorganized behavior. 

• Difficulty establishing a routine. 

• Forgetfulness. 

• Misplacing things. 

• Shifting activities prematurely. 

• Low frustration tolerance. 

• Frequent daydreaming. 

• Hyperactivity.

Considerable symptom overlap between bipolar disorder and ADD may lead to diagnostic confusion.  Twenty-one percent of childhood ADD patients will develop bipolar disorder and 10 percent of ADD adults have a risk of developing bipolar disorder. 

Key distinguishing features of ADD include rereading material, shifting activities and poor concentration. 

While diagnostic features of BPD include elation, grandiosity, racing thoughts, decreased need for sleep and severe mood instability.  

Untreated ADD can lead to substance abuse as patients seek to relieve symptoms by self-medicating.  If ADD is consistently treated, the risk of substance abuse is the same as in the general population.  

Psychostimulant treatment of ADD appears to protect against the development of substance abuse.  

Medications used to treat ADD include:  

Adderall (dextroamphetamine + amphetamine)—amphetamines enhance the release of presynaptic dopamine and block reuptake of dopamine.  

• A study involving over 2600 subjects showed the efficacy of Adderall exceeding that of other medications. 

• Once the proper dose is reached response is almost immediate. 

• At the proper dose patients often report a feeling as if a spotlight has been focused on the task at hand. 

• Interestingly, patients report less anxiety when taking Adderall because their anxiety about failure to get things done has diminished. 

• If patients report increased anxiety the diagnosis is wrong or the dose is too high.   

Ritalin (methylphenidate)—blocks the reuptake of dopamine. Most often used to treat ADHD in children. 

Strattera (atomoxetine)—a norepinephrine reuptake inhibitor that is the first nonstimulant approved by the FDA for treatment of ADD.  Side effects include hypersomnia, nausea, dizziness and GI distress. I have found this medication to be ineffective in my clinical practice.  

Wellbutrin XL—multisite study showed efficacy.  

Tricyclics—1000 subjects in 13 controlled studies showed TCAs effective in every study.  Side effects limit their use.

Composition Thoughts

Writing style has changed since Strunk and White wrote Elements of Style. Certainly concise, crisp sentences and active verbs remain the rule for us all. 

But now sentences sometimes begin with but or because or and. Incomplete sentences and one word sentences add punch to an essay. 

Dangling participles abound. As Winston Churchill said: “Ending a sentence with a preposition is something up with which I will not put.” 

For some reason commas are used less often. (Can someone tell me why?)

As a blogger for the general public (not a specialty writer), I have found that:

1. The reader's short attention span demands that bloggers omit formal expository prose.

2. One to three sentences mandate a paragraph even when good writing requires no paragraph.

3. Bullets and numbers are used more often.

4. More than 350 words provide too much information.

Graduation for All

Every year at graduation time Oh, The Places You'll Go by Dr. Seuss soars to the top of the New York Times bestseller list. 

His words are good news, 

whether you are ninety-five or twenty-five; 

twenty-two, eighteen or even five—

any age you choose. 

I have selected a few verses that are appropriate for all of us:

You’re off to Great Places!  

You’re off and away! 

You have brains in your head.  

You have feet in your shoes. 

You can steer yourself any direction you choose. 

I’m sorry to say so, but, sadly, it’s true 

that bang-ups and hang-ups can happen to you. 

When you’re in a Slump, you’re not much fun. 

Un-slumping yourself is not easily done. 

Do you dare to stay out?  

Do you dare to go in?  

How much can you lose?  
How much can you win? 
Simple it’s not, I’m afraid you will find, 

for a mind-maker-upper to make up his mind.  

You can get so confused that you’ll start in to race down long wiggled roads at a break-necking pace, 

and grind on for miles across weirdish wild space,

headed, I fear, toward a most useless place.  

The Waiting Place …for people just waiting.  

Waiting for a train to go or a bus to come, 

or a plane to go or the mail to come, 

or the rain to pour or the phone to ring, 

or the snow to snow.  

No! 

That’s not for you! 

You’ll escape all that waiting and staying. 

You’ll find the bright places where Boom Bands are playing.  

There is fun to be done! 

There are games to be won. 

Step with care and great tact, 

remember that Life’s a Great Balancing Act. 

And will you succeed? 

Yes! You will, indeed! 

(98 and ¾ percent guaranteed.) 

Today is your day!  

Your mountain is waiting. 

So…get on your way